By speaking up for safety and equality, we can improve health care for all.
The summer between her junior and senior years at Brown, an aspiring pre-med student secured what she believed to be an amazing opportunity: a coveted summer internship with a hand surgeon in Washington, DC.
On the second floor of the Maddock Alumni Center, she had searched through the three-ring binders overflowing with opportunities. Finally, after concentrating on the academic and theoretical aspects of pursuing a career in medicine, she wanted the experiential: she could not wait to observe surgery in the operating room and to assist at office hours.
Then. Day one. The surgeon put his arm around her in a way that instantly felt not quite right. By the second morning, before a full day of office hours, he forcefully tried to kiss her. And he tried again. And again.
Angered by her silence, as well as by her repeated rebuffs of his overtures, he yelled at her.
“Listen. You better get used to this. It’s going to happen a lot to you in medicine.”
Her male pre-med friend had completed the same summer internship one year prior and had raved about this surgeon and the experience. In contrast, she was left asking herself questions with answers that could significantly alter her future: Should I apply to medical school? Am I strong enough? Am I equipped to navigate this? Should I expect this from all men in medicine? Although there is nothing else I can see myself doing, should I become a doctor?
Not an Isolated Case
Data about sexual harassment of women in medicine indicate that this young woman’s experiences were not exceptional. In June 2018, the National Academies of Science, Engineering, and Medicine (NASEM) released a report detailing the high prevalence of sexual harassment directed toward women in these disciplines. Over more than 300 pages, the report outlined startling and sobering statistics: that more than half of women faculty—and nearly as many students—report harassment that ranges from gender-based discrimination to crude behaviors to unwanted sexual attention, sexual coercion, and assault. Thus, although the details are unique for each woman, the stories aren’t really that different.
The NASEM report also described the host of negative consequences for women who experienced these forms of discriminatory behaviors. The adverse impacts are dire, and include deleterious effects on a woman’s personal health, such as higher rates of depression and anxiety, and negative career and educational outcomes including decreased productivity, lower grades, relinquishing leadership positions, leaving the institution, and even leaving medicine or science altogether. Perhaps most disheartening was the finding that the least common response to the experience of sexual harassment was for the woman to report it formally. Fears of retaliation, not being believed, and other negative personal and professional consequences are often cited as the reasons that women don’t report. Equally disturbing is the observation that the best predictor of continued gender-based discrimination and harassment is the perception that the institutional culture tolerates these behaviors.
So there’s the problem. Women are afraid to report. Without reporting, corrective actions are unlikely or impossible. Without corrective actions, the institutional culture does not reject harassment, and the behaviors are perpetuated. Nothing changes.
What does this mean for the field and for patients? Here the data are clear: patient care suffers when gender equity is not a priority.
Diverse clinical and research teams are more innovative, productive, effective, and creative. Breakthroughs like sequencing the human genome, development of antiretroviral medications, and creation of the HPV vaccine resulted from multidisciplinary teams representing many perspectives and encompassing broad expertise. Situations that lead women in medicine and biomedical sciences to not pursue their career passions or to leave the workforce ultimately have the consequence that talented, competent, creative, and diverse minds are not contributing to patient care.
Time’s Up
So what’s the answer? It is time to raise the standards of acceptable behavior in the work and educational environments of medicine and biomedical sciences.
On March 1, TIME’S UP Healthcare, an initiative of the Time’s Up Foundation, a 501(c)(3), held its national launch in New York City at the New York Academy of Medicine. As a part of this launch, we and a few other members solicited schools, hospitals, and institutions to join as founding signatories.
Signatory institutions are health professional schools and institutions, such as large health systems and practices that employ at least 100 health care workers. This threshold was established to ensure that signatories have the capacity with the infrastructure support to effect meaningful change.
Founding signatories joined in advance of the TIME’S UP Healthcare launch. Eight medical schools, hospitals, and institutions stepped forward and committed. The Warren Alpert Medical School was one of them. Brown is proud to be a founding signatory institution. They were among the first to sign and make public a commitment to three tenets:
- Sexual harassment and gender-based discrimination have no place in the health care workplace. We are committed to preventing sexual harassment and discrimination, and protecting and aiding those who are subject to harassment and discrimination.
- We believe women should have equitable opportunity, support, and compensation.
- We will measure and track sexual and gender harassment and inequity occurring within our institution.
Since the original eight institutions joined, 34 more have become signatories, including the Lifespan health care system, which includes several Brown-affiliated teaching hospitals. TIME’S UP Healthcare has set a goal of enrolling 100 signatories by 2020.
Based on the NASEM findings, sexual harassment occurs at all academic medical centers. These behaviors have not been eradicated for many reasons, including underreporting, lack of awareness, and insufficient resources for addressing genderbased mistreatment. TIME’S UP Healthcare has called attention to the reality that all medical workplaces are struggling in some respect when it comes to addressing these problems. We are here to align with and support organizational efforts to achieve equity and safety and to create a strong and inclusive workforce that can provide the best possible care to its patient population.
So what happened to the Brown pre-medical student when she returned for the fall semester of her senior year? She reported the experience to the alumni office. The summer internship was immediately removed from the listings. With the encouragement of faculty mentors, she completed applications to medical school and pursued a career in medicine.
Not all women do.
It’s time to stop gender-based discrimination and harassment in health care.
